Five-Year Review of the Advanced Interventions Service

Executive Summary

In 1996, the Scottish Office Clinical Resource and Action Group (CRAG) Working Group on Mental Illness made a series of recommendations that laid the foundations for the development of the existing service providing neurosurgery for mental disorders in Ninewells Hospital. The group recognised the role of neurosurgery for some well defined types of mental disorder.

Subsequently in 2000, a Royal College of Psychiatrists Neurosurgery for Mental Disorder report complimented a number of the CRAG findings, noting that “it would be unwise to allow neurosurgery for mental disorder to die out.” The foresight of the CRAG and Royal College reports has proved to have been invaluable, with the current review finding that the Advanced Interventions Service has provided a highly valuable service for people from across Scotland and the rest of the UK. The review recommends that the Advanced Interventions Service should continue to be nationally designated.

The review recognises the high quality of the service provided and the clinically significant improvements in mental health experienced by people with highly chronic and severe depression following a neurosurgical intervention carried out by the service. This is against the context of having tried a significant number of other failed treatments for their chronic and severe depression and/or chronic and severe OCD. Patient feedback about the Advanced Interventions Service has been very positive, highlighting the positive person‐focus of the service, the staff’s respectful approach to their patients, and the necessary mutual involvement in decision‐making about their package of care.

Clinical feedback on the Advanced Interventions Service has also been complimentary, with a high proportion of respondents to a review survey noting that their overall experience of the service was either ‘good’ or ‘very good.’

The review recommends that the service continues in its existing areas of good practice including its robust assessment process, in capturing patient feedback, in developing the evidence‐base in partnership with the University of Dundee, and in undertaking vigorous audit. A number of recommendations were also made to bring about further improvement in the service. These recommendations will assist the service to improve communication with the clinical community to better manage and develop referrals from non‐Scottish home nations, and to continue to benchmark across the UK.

The review recognises that the majority of the service’s activity to date has been nonsurgical, for instance; in providing comprehensive patient assessments, home visits,
treatment recommendations, an educational programme, and clinical advice to other clinical teams. This activity is acknowledged as entirely appropriate, and the review recommends that the service should be better recognised for this work. It is recommended that the service specification is amended to take this into account, and that the service reports more fully on these processes in the future.

Whilst out of scope of this review, the findings draw attention to a perceived inequity in provision of OCD services across NHS Scotland, which has an impact on the quality of referrals into the service, the ongoing management of the patient post‐intervention, and a low conversion rate to surgery. It is recommended that in order to appropriately recognise and develop tertiary OCD services, a mapping of service‐need and existing provision for people with OCD be undertaken by NHS Scotland or the Scottish Government.

Furthermore, whilst Scottish residents with OCD who require access to quaternary level psychopharmalogical and psychiatric services currently have access to services in England, it is apparent that there is the expertise to provide this level of service in NHS Scotland. The review therefore invites relevant services with appropriate expertise and capacity to apply to the National Services Advisory Group for national designation. If capacity can be developed to provide this level of specialised psychopharmacological, psychiatric and other treatments for OCD in Scotland, then NHS Scotland service providers should consider making an application to provide this level of service to the National Services Advisory Group.

It is hoped that developing the Advanced Interventions Service in the areas recommended by the review, and addressing these structural issues, will support the continuing successful provision of a high‐quality national service over the next five years.